To maintain quality of patient care in the future, changes need to be made in the training and use of allied and auxiliary health care workers—hospital support staff such as physical therapists, technicians, aides, and assistants—according to a report released by the California Twenty-First Century Workforce Project.

The project is an initiative by the UCSF Center for the Health Professions and is funded by the California HealthCare Foundation.

“Allied and auxiliary workers suffer from high turnover rates, ill-defined expectations, low pay, and inadequate training,” according to Jonathan Showstack, PhD, UCSF professor of medicine and health policy and co-director of the UCSF Center for the Health Professions.  “We need to change how we train and use these workers.  Otherwise, patient care is likely to suffer.”

Allied and auxiliary workers, which include over 200 professions and occupations, make up 60 percent of the country’s 10.5 million-person health care workforce, according to the report.

These workers are being affected more than other health professions by the changes in the health care system, however, their concerns and contributions are often overlooked by health care institutions, researchers, and policy makers, said Showstack. 

The report titled The Hidden Health Care Workforce: Recognizing, Understanding, and Improving the Allied and Auxiliary Workforce identified three contributing factors to the problems facing this workforce: health care delivery organizations are struggling to survive in California’s competitive health care market; workers are being asked to be more flexible, more tolerant of uncertainty, and more capable team members; and educators are having difficulties preparing future workers with appropriate skills. 

The report stresses that the future of the allied and auxiliary workforce depends on health care delivery organizations, workers, and educators and recommends that these groups build partnerships that will forge new approaches to education, retraining, job structuring, and career opportunities.  These changes will be essential ingredients to ensuring that the health system is affordable and responsive to consumer needs, said Showstack.

## The report identifies seven core themes which represent the challenges of reinventing the allied and auxiliary workforce:

* New Divisions of Labor
* Lower Pay With More Responsibility
* The Struggle to Attract and Retain a Quality Workforce
* Tying Human Resources to a Quality Strategy
* Regulatory and Oversight Inconsistency
* A Widening Gap between Education and the Needs of Industry
* The Changing Nature of Work and Career Advancement

## The report further provides the following recommendations to make the allied and auxiliary work force more responsive to consumer needs:

* Align workers’ skills with health care delivery standards which reflect general employment skills as well as core clinical and technical competencies and training programs that meet the requirements and standards that are aligned with health care delivery standards. 
* Prepare the workforce to deliver culturally sensitive healthcare.
* Create new types of work environments that emphasize quality, flexibility, service and cultural diversity.
* Prepare the workforce to improve the quality of patient care.
* Encourage participation among labor, education, and the workforce in order to promote change and quality improvement.
* Encourage allied and auxiliary workers to take advantage of career development programs to expand their opportunities.
* Change state regulations of these workers to allow more flexibility in the workplace.

“Health care is a labor intensive effort.  Unless we are able to change the way the work is done, the way health workers are trained, and the attractiveness for the health care employment sector, we have little chance of sustaining long-term change in health care,” said Mark Smith, president of the California HealthCare Foundation. 

The study was co-authored by Jennifer Ruzek, BA, program director;  Lindsey Bloor, BA, MS, research associate; Jennifer Anderson, BA, program assistant; and Mai Ngo, BA, research assistant, all of the UCSF Center for the Health Professions. 

The UCSF Center for the Health Professions seeks to assist health care professionals, health professions schools, health care delivery organizations, and public policy makers in responding to the challenges of educating and managing a health care workforce capable of improving the health and well being of people in their communities.

The UCSF Center for the Health Professions is part of the UCSF Center for Health and Community, a multidisciplinary center which assesses the challenges of the changing health care delivery environment and identifies policies and interventions to maximize the beneficial impact of the changing health care delivery system.  The Center for Health and Community is comprised of programs and individual faculty from all UCSF Schools who have been at the cutting edge of health services and policy-related research for many years, and includes basic social and behavioral scientists in epidemiology, health policy, anthropology, psychology, sociology, history, bioethics, economics, and clinical research.

The California HealthCare Foundation, located in Oakland, is a nonprofit philanthropic organization whose mission is to expand access to affordable, quality health care for underserved individuals and communities and to promote fundamental improvements in the health status of the people of California.